Which professional or form of therapy is the right point of contact for a distressing shoe fetish?

01 · Sexual health

Introduction

For most people, a psychotherapist with experience in sexuality is a good first point of contact. Depending on the concern, sex therapy, sexual medicine, couples therapy or a medical examination may also be a better fit. More important than the exact professional title is that the person knows the subject and does not judge you.

02 · Sexual health

Who does what

Professional titles in health care are often confusing for laypeople. Here is a brief overview of the points of contact that may be considered for a distressing shoe fetish in Germany:

• Psychotherapy: Licensed psychotherapists treat psychological distress such as shame, anxiety, low mood or compulsiveness. If a disorder requiring treatment is present, statutory health insurance generally covers the costs.
• Sex therapy: This is an additional qualification that psychotherapists, doctors or counsellors can acquire. It specialises in sexual issues, but is often paid for privately.
• Sexual medicine: Doctors with further training in sexual medicine combine physical and psychological aspects. Some university hospitals have their own sexual-medicine outpatient clinics.
• Psychiatry: Specialist doctors in psychiatry are important if depression, severe anxiety or obsessive thoughts are also present.
• Couples and sex counselling: If the relationship is suffering above all, joint counselling may make more sense than individual therapy.
• Urology and general practice: In the event of erectile problems, physical causes such as age, medication or illnesses should also be clarified.

03 · Sexual health

Which point of contact suits which concern

The following overview is guidance, not a fixed rule:

• Your concern: Possible first point of contact
• Shame, self-doubt, feeling compulsive: Psychotherapy, preferably with experience in sex therapy
• Uncertainty about whether there is a disorder at all: Sexual medicine or psychotherapy
• Conflicts in the relationship because of the fetish: Couples or sex therapy
• Erectile problems: General practitioner or urology, with sexual medicine in addition
• Low mood, anxiety, distressing thoughts: Psychotherapy or psychiatry
• Impulses to overstep other people's boundaries: Psychotherapy or a sexual-medicine outpatient clinic immediately
• No idea where to start: General practitioner

04 · Sexual health

Which form of therapy?

I am not aware of comparative studies on which form of therapy helps best with a distressing shoe fetish. The established approaches have different emphases. Behavioural approaches focus above all on thoughts, habits and behavioural patterns in the here and now. Psychodynamic approaches inquire more into one's own history and inner conflicts. Systemic approaches consider the relationships in which you live.

What therapy should not be, by contrast, is an attempt to train your fetish out of you. Older professional literature contains reports of so-called aversive treatments that attempted exactly that. These are historical individual cases and no basis for treatment today. A good professional works with you on your distress, not against your sexuality.

From my point of view, the method is less decisive than the fit. You need someone with whom you can speak openly. A survey of people with kink and fetish interests from the San Francisco region showed exactly this: above all, participants wanted practitioners who were knowledgeable and did not shame them.

05 · Sexual health

How to find someone

In Germany, the appointment service at 116 117 arranges appointments for an initial psychotherapy consultation. General practitioners can also help. Many professionals state their areas of focus on their websites. Look out for terms such as sex therapy, sexual medicine or sexual diversity.

There are trial sessions before psychotherapy begins. Use them to find out whether the chemistry is right. You are also entitled to ask:

By the way, you do not need a diagnosis to get support. If shame or uncertainty is what troubles you most, counselling may also be the right place. Counselling centres such as pro familia offer conversations about sexuality and relationships, often at low cost or free of charge.

• Do you have experience with fetishes?
• How do you see fetishism: as a disorder or as part of sexual diversity?
• What would be a sensible goal for me from your point of view?
• If you do not like an answer, you are free to keep looking.

06 · Sexual health

What helped me

When my wife and I were going through a difficult phase a few years ago, I found a female psychologist who was well versed in fetishes and BDSM. That made the difference for me. I was able to describe my situation to her very openly without having to fear that she would judge me for it. Her outside perspective opened up a new view of my sexuality for me. I kept the fetish. What changed was how I dealt with it.